Mass azithromycin distribution for hyperendemic trachoma following a cluster-randomized trial: A continuation study of randomly reassigned subclusters (TANA II)

被引:35
作者
Keenan, Jeremy D. [1 ,2 ]
Tadesse, Zerihun [3 ]
Gebresillasie, Sintayehu [3 ]
Shiferaw, Ayalew [3 ]
Zerihun, Mulat [3 ]
Emerson, Paul M. [4 ]
Callahan, Kelly [4 ]
Cotter, Sun Y. [1 ]
Stoller, Nicole E. [1 ]
Porco, Travis C. [1 ,2 ,5 ]
Oldenburg, Catherine E. [1 ,2 ,5 ]
Lietman, Thomas M. [1 ,5 ]
机构
[1] Univ Calif San Francisco, Francis I Proctor Fdn, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Ophthalmol, San Francisco, CA 94143 USA
[3] Carter Ctr, Addis Ababa, Ethiopia
[4] Carter Ctr, Atlanta, GA USA
[5] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
关键词
SINGLE-DOSE AZITHROMYCIN; CHLAMYDIA-TRACHOMATIS; ANTIBIOTIC DISTRIBUTIONS; ELIMINATION; IMPROVEMENT; RESISTANCE; INFECTION; COMMUNITY; ETHIOPIA; IMPACT;
D O I
10.1371/journal.pmed.1002633
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The World Health Organization recommends annual mass azithromycin administration in communities with at least 10% prevalence of trachomatous inflammation +/- follicular (TF) in children, with further treatment depending on reassessment after 3 +/- 5 years. However, the effect of stopping mass azithromycin distribution after multiple rounds of treatment is not well understood. Here, we report the results of a cluster-randomized trial where communities that had received 4 years of treatments were then randomized to continuation or discontinuation of treatment. Methods and findings In all, 48 communities with 3,938 children aged 0 +/- 9 years at baseline in northern Ethiopia had received 4 years of annual or twice yearly mass azithromycin distribution as part of the TANA I trial. We randomized these communities to either continuation or discontinuation of treatment. Individuals in the communities in the continuation arm were offered either annual or twice yearly distribution of a single directly observed dose of oral azithromycin. The primary outcome was community prevalence of ocular chlamydial infection in a random sample of children aged 0 +/- 9 years, 36 months after baseline. We also assessed the change from baseline to 36 months in ocular chlamydia prevalence within each arm. We compared 36-month ocular chlamydia prevalence in communities randomized to continuation versus discontinuation in a model adjusting for baseline ocular chlamydia prevalence. A secondary prespecified analysis assessed the rate of change over time in ocular chlamydia prevalence between arms. In the continuation arm, mean antibiotic coverage was greater than 90% at all time points. In the discontinuation arm, the mean prevalence of infection in children aged +/- 9 years increased from 8.3% (95% CI 4.2% to 12.4%) at 0 months to 14.7% (95% CI 8.7% to 20.8%, P = 0.04) at 36 months. Ocular chlamydia prevalence in communities where mass azithromycin distribution was continued was 7.2% (95% CI 3.3% to 11.0%) at baseline and 6.6% (95% CI 1.1% to 12.0%, P = 0.64) at 36 months. The 36-month prevalence of ocular chlamydia was significantly lower in communities continuing treatment compared with those discontinuing treatment (P = 0.03). Limitations of the study include uncertain generalizability outside of trachoma hyperendemic regions. Conclusions In this study, ocular chlamydia infection rebounded after 4 years of periodic mass azithromycin distribution. Continued distributions did not completely eliminate infection in all communities or meet WHO control goals, although they did prevent resurgence.
引用
收藏
页数:17
相关论文
共 39 条
[1]  
[Anonymous], 1949, PRINCIPLES ANIMAL EC
[2]   Simplification and improvement of height-based azithromycin treatment for paediatric trachoma [J].
Basilion, EV ;
Kilima, PM ;
Mecaskey, JW .
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, 2005, 99 (01) :6-12
[3]  
Bowman RJC, 2000, INVEST OPHTH VIS SCI, V41, P4074
[4]   Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma [J].
Chidambaram, JD ;
Alemayehu, W ;
Melese, M ;
Lakew, T ;
Yi, E ;
House, J ;
Cevallos, V ;
Zhou, ZX ;
Maxey, K ;
Lee, DC ;
Shapiro, BL ;
Srinivasan, M ;
Porco, T ;
Whitcher, JP ;
Gaynor, BD ;
Lietman, TM .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2006, 295 (10) :1142-1146
[5]   Mass antibiotics for trachoma and the Allee effect [J].
Chidambaram, JD ;
Lee, DC ;
Porco, TC ;
Lietman, TM .
LANCET INFECTIOUS DISEASES, 2005, 5 (04) :194-196
[6]  
Diamant J, 2001, Ophthalmic Epidemiol, V8, P109, DOI 10.1076/opep.8.2.109.4156
[7]   Face washing promotion for preventing active trachoma [J].
Ejere, Henry O. D. ;
Alhassan, Mahmoud B. ;
Rabiu, Mansur .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2015, (02)
[8]   Progress and projections in the program to eliminate trachoma [J].
Emerson, Paul M. ;
Hooper, Pamela J. ;
Sarah, Virginia .
PLOS NEGLECTED TROPICAL DISEASES, 2017, 11 (04)
[9]   Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial [J].
Emerson, PM ;
Lindsay, SW ;
Alexander, N ;
Bah, M ;
Dibba, SM ;
Faal, HB ;
Lowe, K ;
McAdam, KPWJ ;
Ratcliffe, AA ;
Walraven, GEL ;
Bailey, RL .
LANCET, 2004, 363 (9415) :1093-1098
[10]   Review of the evidence base for the 'F' and 'E' components of the SAFE strategy for trachoma control [J].
Emerson, PM ;
Cairncross, S ;
Bailey, RL ;
Mabey, DCW .
TROPICAL MEDICINE & INTERNATIONAL HEALTH, 2000, 5 (08) :515-527